Want to do better with cardiac surgery: Exercise to help fight depression

Harold Mandel's picture
Walking to stay in shape

Cardiac surgery can sometimes save lives, but patients could suffer and die from associated depression if they do not stay as active as possible prior to and after their surgery. If heart disease becomes so serious that cardiac surgery appears to be the only viable way to help, patients must be prepared to take an active role in their own recovery. It's true that heart disease is a killer if not treated properly. Depression can also result in premature death from suicide and other associated mishaps, and so understanding the association between cardiac surgery and depression should position patients to help fight this problem.

It has been found that physical activity is linked to a lower prevalence of depressive symptoms in cardiac patients, reports the Canadian Journal of Cardiology. After cardiac surgery up to 40 percent of patients are depressed. The strongest independent associations postoperatively have been found to be preoperative depression and postoperative stressful events. Researchers observed physical inactivity was associated with preoperative depression and new depressive episodes 6 months postoperatively.

In fact, physical inactivity after cardiac surgery is linked with a substantially higher risk of depression, reports Elsevier via AlphaGalileo in a discussion of this research. The researchers said patients undergoing cardiac surgery should be assessed for depression and physical activity. New research has indicated that inactive patients following cardiac surgery have a significantly higher risk of depression and that the number of patients who are suffering from depression after cardiac surgery is as high as 40 percent.

It has been suggested by the researchers that cardiac patients should be assessed for signs of depression and level of physical activity. Patients should remain as active as they safely can after surgery in order to minimize post-operative depression. It should be kept in mind that major depressive disorder is itself an independent risk factor for the development of coronary artery disease along with increases in the risk of serious cardiac events and premature death. It has been estimated that among patients with coronary artery disease who need cardiac surgery, depression ranges from 23 percent to 47 percent, which is higher than the general coronary artery disease population.

It has been observed that in the coronary artery disease population, which includes those who have had a heart attack, depression is about twice as common as in the general population without cardiac disease. About 50 percent of the patients suffering from depression prior to cardiac surgery remain depressed one year after surgery. And an additional 20 percent of patients who undergo coronary artery bypass surgery experience new or elevated depressive symptoms after the surgery. More cardiac complications are increased after cardiac surgery when moderate to severe depression is experienced.


Evidence which describes the change in physical activity status prior to and after cardiac surgery, and whether physical activity status is actually associated with depressive symptoms after surgery, has been limited. Therefore, researchers from the University of Manitoba decided to to define who is at risk for depression after surgery. The also wanted to determine whether all patients experience similar mood changes. Furthermore, they wanted to determine how and when physical activity changes, and how this has can affect depression after surgery.

The researchers conducted the Impact of Physical Activity on Depression After Cardiac Surgery (IPAD-CS) study. They assessed 436 patients who were undergoing elective cardiac surgery or who were awaiting in-hospital cardiac surgery which required cardiopulmonary bypass in 2010-2011. The patients were evaluated for short-term depression and physical activity behavior prior to surgery, at the time of hospital discharge, and than at three and six months after surgery. Prior to surgery patients were categorized as “depression naïve,” “at risk,” or “depressed”. They were also categorized as physically “inactive” or “active” based on their activities over the preceding seven days.

The results demonstrated that physical inactivity was an independent risk factor for increased depressive symptoms prior to surgery. Inactive patients were found to have double the risk of experiencing depressive symptoms prior to surgery. After the surgery preoperative depression and postoperative stressful events were observed to be the strongest associations. It was observed that being physically inactive was associated with preoperative depression and new depression six months after surgery. Of particular interest was the finding that 58 percent of the “at-risk” group progressed to clinical depression after surgery, in comparison to 28 percent in the “naive” group. And 23 percent remained depressed after six months.

It was also observed that stressful events, such as death in family, divorce, and living alone, became significantly associated with depression at three and six months after the surgery. This has suggested that the factors which predispose patients with cardiac disease to increased symptoms of depression are not actually fixed and vary over the course of time. In a subgroup of patients who were not depressed at baseline, but who later became depressed by the three- or six-month follow-up period, a significant decrease in physical activity from baseline to six-month follow-up was seen, in comparison to those who remained free from depression. The investigators pointed out that it became perplexing to determine whether reduced physical activity increased depressive symptoms or, conversely, if depression actually instead resulted in sedentary behavior.

Antidepressant medications have been the mainstay of current treatment for depression. But, the use of antidepressants has been controversial, particularly in patients suffering from coronary artery disease. Previous studies have demonstrated that exercise as a treatment among patients with coronary artery disease is as effective as antidepressants for lowering depressive symptoms. However, it has not yet been shown if physical activity has a similar effect in patients undergoing cardiac surgery who already suffer from depression.

The researchers have said, “Depression in the patient undergoing cardiac surgery appears complex.” They have observed that there are different mood responses in different subsets of patients. They have also defined a new high-risk subset of patients who are ‘at risk’ for depression. Not being physically active prior to surgery poses an independent two-fold risk for depression before surgery and is associated with the development of new depression after surgery. Moderate exercise can save you from the dangerous despair of depression, as I have reported on in a separate article for EmaxHealth.

It has been my observation that patients are generally initially very frightened about cardiac surgery. Fears of this surgery often set off anxiety and depression syndromes. Encouraging patients to exercise prior to surgery, not just after surgery, clearly can help lessen anxiety and depression symptoms all along. This can all roll over into better emotional well being and a more fit body to handle the stress associated with cardiac surgery. So we are seeing again, as in dealing with all parameters of good emotional and physical well being, that exercise is a vitally important factor for good outcomes. I therefore suggest that all cardiac patients be advised to stay in shape, of course under supervision of their physicians to avoid too little or too much exercise. Exercise can be seen as a magic drug for depression and anxiety, writes EmaxHealth reporter Denise Reynolds, RD.